# Localised prostate cancer, very low and low risk

Source: https://onco.cc/cancers/prostate-low-risk/  
OnCo record `prostate-low-risk` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Low-risk prostate cancer is Grade Group 1 disease confined to the gland with a PSA under 10. It grows so slowly that watching it closely is the recommended first choice, and most men who choose surveillance never need treatment.

## Summary

Very low and low risk localised prostate cancer is defined by the NCCN as clinical stage T1 to T2a, Grade Group 1 (Gleason 3+3) and PSA below 10 ng/mL; very low risk adds fewer than three positive cores, under half of any core involved and a PSA density below 0.15. It is found by PSA testing followed by MRI and targeted biopsy, the pathway PRECISION showed finds more dangerous cancers with fewer needles. Active surveillance, with PSA every six months, repeat MRI and repeat biopsy, is the preferred option: ProtecT followed 1,643 men for fifteen years and found prostate cancer deaths of around 3 percent in every arm, whether monitored, operated on or irradiated. Men who prefer or later need treatment have radical prostatectomy, external beam radiotherapy (now moderately hypofractionated after CHHiP, or five fractions of stereotactic radiotherapy after PACE-B) or brachytherapy, without hormone therapy. Genomic classifiers and AI pathology can refine who is safe to watch, and germline testing is offered when the family history suggests it.

## Fields

- Kind: Cancer
- Last checked: 2026-09-25
- Also known as: Low-risk prostate cancer; Very low risk prostate cancer; Grade Group 1 prostate cancer; NCCN very low and low risk; Cambridge Prognostic Group 1; CPG 1; CPG1 prostate cancer; Grade group 1 prostate cancer
- Tags: subtype-page
- Group: genitourinary
- Burden: Roughly a third of prostate cancers diagnosed in screened populations; fewer than one in a hundred men with low-risk disease die of it within fifteen years whether monitored or treated.
- Subtypes: Very low risk (T1c, Grade Group 1, PSA under 10, fewer than 3 cores, PSA density under 0.15); Low risk (T1 to T2a, Grade Group 1, PSA under 10); Localised acinar adenocarcinoma, Grade Group 1
- Biomarkers: PSA and PSA density; Gleason Grade Group 1 on biopsy; MRI PI-RADS score; Genomic classifier (Decipher, Oncotype DX GPS, Prolaris); Germline BRCA2 testing when family history warrants

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/prostate-low-risk/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/prostate-low-risk/#overview [3 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/prostate-low-risk/#what-it-is [3 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/prostate-low-risk/#finding-it [5 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/prostate-low-risk/#treating-it [3 settings, 3 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/prostate-low-risk/#evidence [14 trials, 17 key papers, 6 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/prostate-low-risk/#science
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/prostate-low-risk/where-you-are/ [1 centre, 26 UK centres]
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/prostate-low-risk/#living-with-it [16 questions, 2 red cards, 1 decision aid]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/prostate-low-risk/coming/ [2 medicines, 14 trials, 2 ideas, 3 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/prostate-low-risk/data/ [71 connected records, 1 note]

## Standard of care

- Very low and low risk, preferred: Active surveillance with PSA every six months, MRI and repeat biopsy; treatment only on progression to Grade Group 2 or more. ([Active surveillance](https://onco.cc/technologies/active-surveillance/), [ProtecT](https://onco.cc/trials/protect/), [Multiparametric prostate MRI (PI-RADS)](https://onco.cc/technologies/mp-mri/), [PSA (prostate-specific antigen)](https://onco.cc/terms/psa/), [Gleason score / Grade Group](https://onco.cc/terms/gleason-grade-group/))
- Low risk, men who prefer treatment: Radical prostatectomy, moderately hypofractionated external beam radiotherapy, five-fraction stereotactic radiotherapy or brachytherapy, without hormone therapy. ([Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/), [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [CHHiP](https://onco.cc/trials/chhip/), [PACE-B](https://onco.cc/trials/pace-b/))
- Diagnosis: MRI before biopsy and targeted plus systematic cores; genomic classifiers or AI pathology to refine surveillance decisions. ([Multiparametric prostate MRI (PI-RADS)](https://onco.cc/technologies/mp-mri/), [PRECISION](https://onco.cc/trials/precision-mri/), [Decipher Prostate](https://onco.cc/drugs/decipher-prostate/), [ArteraAI Prostate](https://onco.cc/drugs/artera-ai-prostate/))

## State of the art

- ProtecT settled that low-risk disease can be watched: fifteen-year cancer mortality was around 3 percent in every arm.
- MRI-first diagnosis finds fewer of these indolent cancers and more of the dangerous ones.
- Surveillance uptake for low-risk disease has risen from a fifth to more than half of eligible men in a decade.

## Open problems

- Which Grade Group 1 cancers will upgrade, and whether Grade Group 1 should be called cancer at all.
- How often to repeat biopsy on surveillance and whether MRI alone can replace it.
- Overdiagnosis by PSA screening against the deaths screening prevents.

## Notes

- What this page is called in the NHS: Cambridge Prognostic Group 1. NICE NG131 recommendation 1.2.15 defines it as Gleason score 6 (grade group 1) and PSA under 10 micrograms per litre and stage T1 to T2, all three together. For CPG 1, NG131 1.3.8 offers active surveillance, and says to consider radical prostatectomy or radical radiotherapy only if active surveillance is not suitable or not acceptable to the person. Isotope bone scans are not routinely offered (1.2.16). The NCCN's very low and low risk bands cover roughly the same ground but add PSA density and the number of positive cores, so the two systems do not select identical men.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Active_surveillance_of_prostate_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Active_surveillance_of_prostate_cancer
- NCCN Guidelines: Prostate Cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459
- NICE NG131: prostate cancer, diagnosis and management (recommendations, including the Cambridge Prognostic Group table at 1.2.15): https://www.nice.org.uk/guidance/ng131/chapter/Recommendations
- Royal College of Pathologists G084: dataset for histopathology reports for prostatic carcinoma, version 4, October 2024: https://www.rcpath.org/static/8cc88604-2c8d-4df4-a99542df41c102af/G084-dataset-for-histopathology-reports-for-prostatic-carcinoma.pdf

## Connected records

- cancers: [Biochemical recurrence of prostate cancer](https://onco.cc/cancers/prostate-bcr/), [Ductal adenocarcinoma of the prostate](https://onco.cc/cancers/prostate-ductal-adenocarcinoma/), [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Localised prostate cancer, intermediate risk](https://onco.cc/cancers/prostate-intermediate-risk/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- terms: [Cambridge Prognostic Group (CPG 1 to 5)](https://onco.cc/terms/cambridge-prognostic-group/), [Choosing treatment for localised prostate cancer: what each option costs](https://onco.cc/terms/prostate-treatment-choice-localised/), [Cribriform growth pattern in prostate cancer](https://onco.cc/terms/cribriform-prostate-cancer/), [Focal and tissue-preserving treatment of prostate cancer](https://onco.cc/terms/prostate-focal-therapy/), [Gleason score / Grade Group](https://onco.cc/terms/gleason-grade-group/), [How many radiotherapy visits: the prostate fractionation trials](https://onco.cc/terms/prostate-radiotherapy-fractionation/), [Lead time, and lead-time bias](https://onco.cc/terms/lead-time-bias/), [Number needed to screen (and number needed to diagnose)](https://onco.cc/terms/number-needed-to-screen/), [Other-cause mortality](https://onco.cc/terms/other-cause-mortality/), [Overtreatment](https://onco.cc/terms/overtreatment/), [Percentage of Gleason pattern 4](https://onco.cc/terms/percentage-gleason-pattern-4/), [PI-RADS (Prostate Imaging Reporting and Data System)](https://onco.cc/terms/pi-rads/), [Polygenic risk score (PRS)](https://onco.cc/terms/polygenic-risk-score/), [PSA (prostate-specific antigen)](https://onco.cc/terms/psa/), [PSA density](https://onco.cc/terms/psa-density/), [PSA kinetics: PSA doubling time and PSA density](https://onco.cc/terms/psa-kinetics/), [Template mapping biopsy (transperineal template prostate mapping)](https://onco.cc/terms/template-mapping-biopsy/), [TNM staging for prostate cancer, and what changed in the 9th edition](https://onco.cc/terms/tnm-prostate-cancer/), [Watchful waiting, and how it differs from active surveillance](https://onco.cc/terms/watchful-waiting/), [Whole-mount pathology](https://onco.cc/terms/whole-mount-pathology/)
- key papers: [D'Amico risk groups: biochemical outcome after radical prostatectomy, external beam radiotherapy or brachytherapy](https://onco.cc/key-papers/paper-damico-risk-groups-jama-1998/), [Detection of individual prostate cancer foci via multiparametric magnetic resonance imaging](https://onco.cc/key-papers/paper-johnson-mpmri-individual-foci-eur-urol-2019/), [ERSPC: screening and prostate cancer mortality in a randomised European study](https://onco.cc/key-papers/paper-schroder-erspc-screening-mortality-nejm-2009/), [Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context](https://onco.cc/key-papers/paper-draisma-lead-time-overdiagnosis-psa-jnci-2009/), [Long-term follow-up of a large active surveillance cohort of patients with prostate cancer (Sunnybrook)](https://onco.cc/key-papers/paper-klotz-active-surveillance-jco-2015/), [Measurement of prostate-specific antigen in serum as a screening test for prostate cancer](https://onco.cc/key-papers/paper-catalona-psa-screening-test-nejm-1991/), [Overdiagnosis and overtreatment of prostate cancer](https://onco.cc/key-papers/paper-loeb-overdiagnosis-overtreatment-prostate-eur-urol-2014/), [PIVOT: follow-up of prostatectomy versus observation for early prostate cancer](https://onco.cc/key-papers/paper-wilt-pivot-prostatectomy-observation-nejm-2017/), [PLCO: mortality results from a randomised prostate cancer screening trial](https://onco.cc/key-papers/paper-andriole-plco-prostate-screening-nejm-2009/), [PRECISION: MRI-targeted or standard biopsy for prostate cancer diagnosis](https://onco.cc/key-papers/paper-precision-mri-targeted-biopsy-nejm-2018/), [PROMIS: diagnostic accuracy of multiparametric MRI and TRUS biopsy in prostate cancer](https://onco.cc/key-papers/paper-ahmed-promis-multiparametric-mri-lancet-2017/), [Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening, 1986 to 2005](https://onco.cc/key-papers/paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009/), [Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate](https://onco.cc/key-papers/paper-stamey-psa-serum-marker-nejm-1987/), [ProtecT: 10-year outcomes after monitoring, surgery or radiotherapy for localised prostate cancer](https://onco.cc/key-papers/paper-protect-nejm-2016/), [ProtecT: fifteen-year outcomes after monitoring, surgery or radiotherapy for prostate cancer](https://onco.cc/key-papers/paper-protect-15-year-nejm-2023/), [USPSTF 2012: screening for prostate cancer, recommendation statement (grade D)](https://onco.cc/key-papers/paper-moyer-uspstf-prostate-screening-ann-intern-med-2012/), [USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over)](https://onco.cc/key-papers/paper-uspstf-prostate-screening-jama-2018/)
- trials: [CHHiP](https://onco.cc/trials/chhip/), [Diagnostic Utility of rhPSMA-7.3 (18F) PET/CT in Men With Prostate Cancer on Active Surveillance](https://onco.cc/trials/nct07285057/), [Efficacy and Safety Study of TOOKAD® Soluble for Localised Prostate Cancer Compared to Active Surveillance](https://onco.cc/trials/nct01310894/), [ERSPC (European Randomized Study of Screening for Prostate Cancer)](https://onco.cc/trials/erspc/), [PACE-B](https://onco.cc/trials/pace-b/), [PIVOT (Prostate Cancer Intervention Versus Observation Trial)](https://onco.cc/trials/pivot/), [PRECISION](https://onco.cc/trials/precision-mri/), [PROMIS](https://onco.cc/trials/promis/), [ProtecT](https://onco.cc/trials/protect/), [Randomized Controlled Trial of CAN-2409 Immunotherapy During Active Surveillance for Prostate Cancer (ULYSSES)](https://onco.cc/trials/nct02768363/), [RTOG 0415](https://onco.cc/trials/rtog-0415/), [RTOG 94-08](https://onco.cc/trials/rtog-9408/), [SPCG-4 (Scandinavian Prostate Cancer Group Study 4)](https://onco.cc/trials/spcg-4/), [TRANSFORM](https://onco.cc/trials/transform-prostate/)
- drugs: [ArteraAI Prostate](https://onco.cc/drugs/artera-ai-prostate/), [Decipher Prostate](https://onco.cc/drugs/decipher-prostate/)
- technologies: [Active surveillance](https://onco.cc/technologies/active-surveillance/), [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [Multiparametric prostate MRI (PI-RADS)](https://onco.cc/technologies/mp-mri/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- roadmaps: [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- ideas: [Judge a prostate screening programme on metastatic presentation, not on incidence or mortality](https://onco.cc/ideas/idea-prostate-metastatic-presentation-as-the-screening-endpoint/), [Publish a per-lesion miss rate for every prostate MRI service before it is allowed to guide focal treatment](https://onco.cc/ideas/idea-prostate-per-lesion-mri-audit-before-focal-treatment/)
- institutions: [Prostate Cancer UK](https://onco.cc/institutions/prostate-cancer-uk/)
- people: [Caroline Moore](https://onco.cc/people/caroline-moore/), [Jenny Donovan](https://onco.cc/people/jenny-donovan/), [Nicholas van As](https://onco.cc/people/nicholas-van-as/)

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JSON: https://onco.cc/api/v1/entities/prostate-low-risk.json